October 1, 2013—People who leave the hospital or an emergency department against medical advice tend to do so before their treatment is complete and often end up returning within a short time frame.

A new study from the Canadian Institute for Health Information (CIHI) shows that, compared with people who completed their treatment, those who left inpatient care against medical advice were more than twice as likely to be readmitted to hospital within a month and three times as likely to visit an emergency department within a week.

Leaving Against Medical Advice: Characteristics Associated With Self-Discharge also found that more than three out of five people who left inpatient care and returned to an emergency department within a week were admitted to inpatient care upon their return.

“Patients who leave the hospital against their physicians’ advice face many health risks, because their treatments may not be complete, they may lack information on how to manage their condition and an adequate follow-up plan may not be in place,” says Dr. Stephen Hwang, a scientist and physician at St. Michael’s Hospital in Toronto. “While people have the right to leave if they want, it is important that they fully understand
the possible consequences of their decision. It’s also the responsibility of health care providers to make appropriate arrangements to minimize the risk of harm for patients who insist on leaving against medical advice.

Thousands of Canadians leave against medical advice each year

CIHI’s study examined data from hospitals across Canada (excluding Quebec) and found that in 2011–2012, more than 21,700 patients left inpatient care against medical advice. CIHI also examined emergency department data from all hospitals in Alberta and Ontario—where comprehensive data is available—and found that during the same time period, almost 53,000 people left against medical advice. That works out to about 1 in every 100 visits.

Those who leave against medical advice more likely to be low-income or to have mental health or substance use issues

According to the study, about one in three people who left inpatient care or an emergency department against medical advice were from the lowest-income neighbourhoods. Additionally, close to half of all people leaving inpatient care had a documented mental illness or substance use disorder. Compared with those who completed their treatment, people who left a hospital bed against medical advice were also younger and more likely to be male.

“People who leave against medical advice do so for various reasons,” explains Jeremy Veillard, CIHI’s Vice President of Research and Analysis. “Understanding who is more likely to leave and why they are leaving can help hospitals develop strategies that encourage people to stay and put alternatives into place to help those who still decide to go.”